New Rules Require Insurers to Provide Clear and Concise Summaries for Policyholders

Friday, February 10, 2012

New Rules Require Insurers to Provide Clear and Concise Summaries for Policyholders

Yesterday, the Departments of Health and Human Services, Labor, and Treasury, jointly published new rules requiring health insurers and group health plans to provide concise and comprehensible information about health plan benefits and coverage to the millions of Americans with private health care coverage.

Specifically, the rules will ensure that consumers have access to 2 key documents to help them understand and evaluate their health insurance choices:

All health plans and insurers will provide an SBC to shoppers and enrollees at important points in the enrollment process, such as upon application and at renewal. A key feature of the SBC is a new, standardized plan comparison tool called "coverage examples," similar to the Nutrition Facts label required for packaged foods. The coverage examples will illustrate sample medical situations, such as such as giving birth (normal delivery) or managing type 2 diabetes (routine maintenance, well controlled), and describe how much coverage the plan would provide so consumers can directly compare one plan to another.

These final regulations apply to disclosures for participants and beneficiaries who enroll or re-enroll in group health coverage through an open enrollment period (including re-enrollees and late enrollees) beginning on the first day of the first open enrollment period that begins on or after September 23.